Archive for April 2022

As our medical technologies advance, it’s not surprising why rates for healthcare services are also rising. Therefore, employers are becoming more interested in self-funded insurance programs, such as reference-based pricing models. Self-funded programs are now primarily used by companies with 200 to 400 employees. By taking care of these expenses themselves, smaller companies are now…

By replacing manual procedures and modernizing administrative processes through the centralization of workflows, Third-Party Administrators save a lot of money. As a result, TPAs can re-price all commercial claims at Medicare rates (Reference Based Pricing) at a percentage of the Medicare authorized amount, as well as price all Medicare-based claims. CMSPricer’s SaaS-based Medicare claims repricing…

Medicare third-party administrators can eliminate manual data entry and centralize workflows to reduce costs. They can re-price all commercial claims based on Medicare rates (Reference Basis Pricing) and rate all Medicare claims based on the Medicare cap.  CMSPricer, a software-as-a-service (SaaS) solution, offers payers and third-party administrators a competitive edge by streamlining clinical, financial, and…